Metastatic Prostate Cancer Mortality Unchanged

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A recent analysis uncovered no consistent improvement in overall or disease-specific survival over a 20-year period among men presenting with de novo metastatic prostate cancer (PCa).

“These data suggest that improvements in survival for patients with advanced disease have not contributed substantially to the observed drop in prostate cancer mortality over the PSA [prostate-specific antigen] era and that the stage migration secondary to PSA screening plays a more prominent role,” urologic oncologist Marc Dall'Era, MD, of the University of California Davis (UC Davis) Comprehensive Cancer Center, and colleagues wrote in Cancer.

PSA testing was introduced in the late 1980s. Acknowledging that PCa mortality has declined by nearly 40% over the last 25 years in the U.S., Dr. Dall'Era and colleagues noted that to their knowledge, the contribution of PSA screening for the early detection of PCa remains unclear and controversial. The group attempted to determine whether survival improvements over time in men with metastatic PCa have contributed to the decline in mortality.

The researchers used the California Cancer Registry to identify 19,336 men aged 45 years and older who received an initial diagnosis of metastatic PCa from 1988 to 2009. The data corroborated previous studies showing a 65% reduction in those initially diagnosed with metastatic cancer since the introduction of PSA testing. Men who received their diagnosis from 1988 through 1992 and from 1993 through 1998, however, had better overall survival than men who received their diagnosis in the most recent era. Disease-specific survival was no better for men who received their diagnosis most recently (2004 through 2009) than for men who received their diagnosis from 1988 through 1997.

“Because the PSA test detects cancer earlier, fewer men go on to be diagnosed with metastatic cancer,” Dr. Dall'Era explained in a statement from UC Davis. “However, there has been no survival improvement for men with metastatic disease to account for the overall mortality decline among all men with prostate cancer.”

Although the survival of men with metastatic PCa has not changed dramatically, whether PSA testing is responsible for the 40% drop in PCa mortality in general is unclear. According to Dr. Dall'Era, these findings suggest that the benefits of PSA screening should continue to be evaluated before “sweeping policy recommendations against its use” are made.

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